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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006415
Report Date: 06/11/2024
Date Signed: 06/11/2024 03:24:59 PM

Document Has Been Signed on 06/11/2024 03:24 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:J AND P HOMES/EUDORAFACILITY NUMBER:
306006415
ADMINISTRATOR/
DIRECTOR:
BARRIOS, PRESCILA S.FACILITY TYPE:
735
ADDRESS:10269 EUDORA AVENUETELEPHONE:
(714) 296-5135
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 6CENSUS: 0DATE:
06/11/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Prescilla Barrios
Melba Santos
TIME VISIT/
INSPECTION COMPLETED:
03:35 PM
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Licensing Program Analysts (LPA) Jerome Haley conducted an announced visit to the facility to conduct the pre-licensing inspection. LPA Haley met with Applicant Prescilla Barrios, Melba Santos and toured the facility.

An initial application for a change in facility type to operate an Adult Residential Facility (ARF) was submitted to CCL on September 21, 2023. The facility has a capacity of 6, of which 1 client can be non-ambulatory. The facility phone number 714.827.5079.

An initial application to operate an Adult Residential Facility, with a capacity of 6 was submitted to the department on September 21, 2023.

Fire clearance: Orange County Fire Authority granted the fire clearance September 28, 2023.

Structure: The facility is one level structure with six bedrooms and two bathrooms.

Kitchen: Clean and organized. Sharps locked under the sink. Perishable food supply in the refrigerator and freezer. Non-perishable food supply in a closet area with a water supply and an additional emergency supply of water.

Food Service: A menu was posted on the wall across from the refrigerator.

Bathrooms: There are 2 bathrooms for clients. All bathrooms had a working toilet, sink and all grab bars were tightly secured to the wall.

Continued on LIC809C pg 1 of 3
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE: DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/11/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: J AND P HOMES/EUDORA
FACILITY NUMBER: 306006415
VISIT DATE: 06/11/2024
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Water Temperature: Hot water was measured in both bathrooms. Hot water was measured at 113.0 degrees F and 109.9 degrees F.

Hygiene Supplies: The facility has an adequate supply of hygiene items on hand. There are hygiene items for all clients in a bathroom cabinet. There’s an additional supply of hygiene items locked in a cabinet in the garage.

Smoke Detectors/Carbon Monoxide Detectors:
Smoke detectors are hardwired and tested operational. There’s a fire extinguisher mounted in the hallway in between room #2 and #3 and one mounted on the wall in the kitchen area near room #4.

Appliances:
There’s one 4 gas burner and griddle stove which lights unassisted, 1 oven, a refrigerator, dishwasher, washer, and dryer. All appliances are clean and operational.

Toxins:
All cleaning supplies and chemicals are kept locked in the garage.

Medications, First-Aid Kit & Book:
Client medications are double locked in the kitchen in a cabinet above the sink. There’s a first aid kit with a manual in the locked medication cabinet and a first aid kit in the disaster kit.

Resident & Staff Files:
The Resident and Staff records will be kept locked in the closet next to the front door across from the kitchen.

Reading Material, Games, Equipment & Materials:
Board games: Sorry, Zingo, Scrabble, Connect 4, Star Wars, etc., and coloring books

Continued on LIC809C

pg 2 of 3

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: J AND P HOMES/EUDORA
FACILITY NUMBER: 306006415
VISIT DATE: 06/11/2024
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Backyard: Clean and organized. Table with a sunshade and chairs. Clear walkways free of obstruction. Self-closing and self-latching gates on both sides of backyard.

Garage: Clean and organized. Washer and Dryer. Refrigerator used to store additional food items.

LPA Haley observed the following items that must be corrected: 1) Half of the roof on the garage needs to be finished, 2) remove the old table from the side of the facility.

The applicant plans on making the necessary corrections and will contact LPA Haley to schedule a follow up pre-licensing inspection.

Exit interview was conducted and a copy of this report was provided.

pg 3 of 3

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
LIC809 (FAS) - (06/04)
Page: 3 of 3